EPISTAXIS Sreedevi k p

52nd batch

BLOOD SUPPLYNASAL SEPTUM

LITTLE’S AREA

EPISTAXIS - DEFINITION

Bleeding from inside the nose

Seen in all age groups as emergency

Sign of local or constitutional cause

Sites of epistaxis Little’s area Above the level of middle turbinate Below the level of middle turbinate Posterior part of nasal cavity Diffuse Nasopharynx

Classification

Anterior

Posterior

ANTERIOR EPISTAXIS

POSTERIOR EPISTAXIS

ANTERIOR More common

Little’s area,ant. Part of lat. Nasal wall

Children /young adult

Trauma

Mild Local

pressure/ant. pack

Less common

Post. Superior part-nasal cavity

>40yrs

Spontaneous; often d/t HTN or arteriosclerosis

Hospitalization Post nasal pack

POSTERIORIncidence

Site

Age

Cause

Bleeding

CAUSES

Local

General

Idiopathic

A.LOCAL

1.Congenital

Unilateral choanal atresia

Meningocoele

Encephalocoele

Glioma

Glioma

2.TRAUMA

Injuries of nose

Intra nasal surgery

Violent sneeze

Fracture of middle one third of face & base of skull

4.Infection

Acute Viral rhinitis

Nasal diphtheria

A/c sinusitis

Chronic Atrophic rhinitis

Rhinitis sicca

Tuberculosis

Syphilis

Rhinosporidiosis

4.Foreign bodies

Non-living Rhinolith

Foreign body

Living

Maggots,leech

6.Atmospheric changes

High altitude

Caissons disease

7.DNS

NASOPHARYNX

Adenoiditis

Juvenile angiofibroma

Malignant tumors

GENERAL

CVS Hypertension Arteriosclerosis Mitral stenosis

Blood disorder Aplastic anemia

Leukemia Hemophilia

Liver disease Hepatic cirrhosis

Kidney disease C/c nephritis

Drugs Salicylates Anti coagulant therapy

Mediastinal compression Tumors

A/c general infection Influenza

Chicken pox Malaria

Vicarious menstruation

MANAGEMENT

Enquire…..

Mode of onset Duration & fequency Site Side Type Any medical ailment Drug intake

FIRST AID

Littles area compression

Trotters method

CAUTERIZATION

IN ANT. EPISTAXIS Anaesthetize bleeding point

Cauterise with bead of silver nitrate/coagulate with electro cautery

Anterior nasal packing

Posterior nasal packing

Or….

Foley’s catheter

Nasal baloon

Endoscopic cautery

Better location of posterior bleed Local anaesthasia with sedation It is coagulated with suction cautery

Elevation of mucoperiosteal flap& SMR operation

Ligation of vessels

External carotid – above origin of sup. Thyroid A.

Maxillary artery Approach via Caldwell-Luc operation

Ethmoidal arteries

General Measures

Sit up with back rest Record blood loss in spitting & vomiting Reassure Mild sedation Check vital signs Maintain haemodynamics-blood transfusion if

required Intermittent oxygenation Investigate & treat

Hereditary hemorrhagic telangiectasia

Osler-Weber-Rendu disease is a genetic disorder that leads to abnormal

blood vessel formation in the skin, mucous membranes

It may lead to nosebleeds, acute and chronic digestive tract bleeding, and various problems due to the involvement of other organs.

Can occur on anterior part of nasal septum

Argon,KTP(Potassium titanyl phosphate) or Nd;YAG laser (neodymium-doped yttrium

aluminum garnet)

Septodermoploasty

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